Gender-Inclusive Language and the CSD Professional

This is Asha Voices. I'm JD Gray. Today, on this last day of Pride Month, we're republishing an episode from the archive. On this episode, you'll hear SLP Greg Robinson break down what you need to know to ensure your clients feel respected. Greg is a faculty member at the University of Arkansas for Medical Sciences and the chair of Lagasp. Asha's LGBTQ+ Caucus. Relevant to this conversation, Greg is non-binary and uses the pronouns they/them. Greg shares guidance on how to approach conversations around gender and what to do if you make a mistake. They tell a personal story of how a healthcare provider's language led them to stop receiving care. I'm JD Gray, and this is Asha Voices. Support for Asha Voices comes from the Hannon Center. Is there a way to offer effective, family-centered intervention online? Discover how the Hannon Center has transformed telepractice into a structured, research-based approach you can trust. Visit Hannon.org/Telepractice. As the chair of Lagasp, Greg Robinson and other Lagasp members recently worked with Asha's Multicultural Issues Board on an Asha resource for audiologists and SLPs. That document provides guidance for supporting and working with gender-diverse people. It includes information about the language CSD professionals can use to demonstrate respect, win talking to, and about gender-diverse clients. That's the subject we'll be talking about today. To begin the conversation, I asked Greg to talk briefly about gender diversity and how it connects to language. Yeah, yeah, I think so. So the big thing that I like to bring home is that using correct pronouns is really something that all of us really understand. Everybody wants people to refer to them as the right pronouns. So it doesn't matter if you're trans or non-binary or anybody else. If you are being referred to by other people, you want to be referred to as the correct pronouns. I think that's lesson number one. But I think that the big thing, just to sort of understand gender diversity, so from the beginning, the mainstream US culture has really been very gender binary. We have gender reveal parties. Everybody asks if you're pregnant, what are you having? It becomes very much an ingrained aspect of our culture that people are either boy or girl, man or woman, male, female. But that doesn't really reflect reality and it never really has, is the truth. So there are cultures from centuries back that we have documented that have recognized third, fourth, fifth genders and I'm just kind of happy that as the mainstream American culture kind of begins to have a lot of different awakenings, this is one of those awakenings that we are having, is that there is a diversity as far as gender. And gender isn't the same as sex. So that's the big important thing to remember is that gender is about how you feel, how you identify, who you're connected with, and just generally how you see yourself in the world. And I think that that's a big misunderstanding that a lot of people have, whereas that's concern. And it's important to remember that biological sex is not always binary either because we have numerous people who are born intersex. So we have lots of cases where people have chromosomes that might not be exactly binary. We have ambiguous genitalia, you know, as with pretty much everything in our world, we like to think of things in simple, clear cut categories, but rarely does reality ever align with those. And as we kind of come to that awakening of the diversity and the complexity of our world, the language changes to incorporate that. And that's something that's kind of important to acknowledge. So sex often refers to matters of biology and gender often refers to matters related to identity and complexity and diversity are present in both. Greg told me a story by the time when their pronouns weren't respected. And it illustrates the effect that healthcare providers can have on clients and patients. This story starts with Greg having back pain. This was a few months after they realized they are non-binary. And to treat the back pain, Greg visited a physical therapist. The first moment when I stepped into the office and I was asked to fill out the form right there on the front page was it asked, you know, what is what is my sex or what is my gender? I can't remember how they termed it. And there were literally two boxes. And I just chose not to check either one. I just left that blank. And then nobody else was introducing themselves with their pronouns. Nobody was really asking. It just seemed like nobody was really thinking that that was something that was important or anything like that. And I was just kind of like, well, okay, I'm just here for my back. That's it. I'm just here to get to feeling better. That's what I need. The physical therapist that saw me was, I don't know. He saw that, you know, oh, you're wearing a beard. Your name is Greg. I can talk to you in a certain way. He was making assumptions based on my appearance, which is what we all do. You know, he kept on referring to me throughout the whole time as, you know, bro, bro, all the time. Like, you know, step over here, bro, and try this exercise. See how that makes you feel, bro. And I wasn't really prepared for how it was actually going to affect me. But I also didn't feel quite the comfort level yet to be able to kind of communicate to him either. And so I just let it go. And then I was supposed to return for probably several weeks after that. And I have to say that, like, I never could. I kept on thinking, okay, I'm going to just go ahead and just do it. And I literally couldn't go back. And so eventually, I told them the reason why I stopped coming over like an employee satisfaction kind of survey that they had done. And I was delighted to know that they were actually taking it very seriously and were implementing some changes from that feedback. But I just think it's a great story because, you know, you may not realize that you've just made the wrong assumption. But by doing so, you know, you're putting your client in an uncomfortable place and making it so that they may not want to come back. You mentioned this was an uncomfortable place. What were you thinking throughout the visit? And how was it making you feel? So honestly, it felt, it felt a little bit like emotional daggers. And also there was this big conflict because I was like, dang it, you like provide training for this, like you should be able to talk to this person and explain to them what's going on. But when it was my own person, and it was very, it's a different experience. I'm actually very grateful I had the experience because I think in a way it sort of gave me a little bit of more empathy for, you know, what my clients might be going through as well on a daily basis. And so I'm grateful for the experience, but I'm also grateful that they're, you know, taking the feedback series and moving in a better direction. One of the reasons I wanted you to share this story is because I think it does speak to how important this is. Because as you mentioned, it led to you not returning and not receiving those additional sessions that may have helped your back. Right. Yes, I think that's absolutely right. And, and beyond that, I mean, so many of our clients are going through so much already. If they're coming to you for a communication disorder, they're coming to you for any reason. There's a stressor that is in their lives, and that's why they're coming to you. And those stressors actually can affect their performance, the way they progress in your therapy, vocally, it can cause tension in the, in the voice and stress causes reflux, which can hurt the voice as well. If there's somebody who is a person who stutters, you know, that stress we know increases stuttering. There's so many ways that stressors like this can really affect our clients. And I think that we owe it to really be open to understanding our patients, our clients, our students at a very personal level so that we can make their experiences the best that we can. It's a matter of respect at the most basic level, but also about the quality of the service that someone can receive. If there's a now an audiologist or speech language pathologist who's listening to this and thinking, I want to take steps to make sure that my clients are feeling respected. We're a few of the first simple things they could do to make sure that they are respecting the pronouns of their gender diverse clientele. It all starts with the first interaction. And usually that first interaction is maybe from the front desk person. You know, I'm from the south. Okay. Y'all, we really love our mams and our serves. And it's something that we use a lot, but we like to really caution people to find other ways that they can show that respect for the person that's not just the ma'am or the sir. I love the suggestion that I think a colleague of mine mentioned to say instead of yes ma'am, yes sir, say yes indeed. I love that. Also the intake form, just asking for pronouns on the intake form. What pronouns do you use is a great place. This of course brought to mind that intake form that Greg mentioned earlier in the episode. Greg said they were only given two options on the form and that factored into a negative experience in the physical therapist's office. I asked Greg what they would suggest. Would leaving a blank space there be an option? Yeah, you can describe your gender and should leave a blank. That's what I do in my clinic. But also, you know, if it's necessary for reason, you can ask what sex were you assigned at birth. That's another way to get at something that you might need to know as far as like, if you need to know, okay, so what are the natural hormones that this person has been exposed to? They've gone through puberty, that kind of a thing. Also, to be clear, like I said, ask for what are your pronouns, but also ask for what honorific they want to use. One of my initial sources of advocacy was that I was finding myself reluctant to go to doctor's appointments because even though I have my PhD and people throughout my day, students and even colleagues if they're in the presence of students will refer to me as Dr. Robinson, which is gender neutral. So awesome with that. When I went to a doctor's office, they would always refer to me as Mr. Robinson because they didn't want me to be confused with the medical doctors that they would have had on staff. And so having that the only place that I ever heard that, it was just, it was actually really, really impactful to me. And rather than just delaying and going to the doctor's office, I actually went and contacted my doctor and asked, you know, can you please just either call me Dr. Robinson or Greg? Greg is fine. Just don't call me Mr. Robinson anymore. And they were super, super receptive to that. But honestly, that could have been fixed on the front end had they actually asked. And you know, one option that needs to be included if there's a drop down box or a choice of honorifics is MIX. So MX is a common non-binary honorific. And also just the option of no honorific is another, another great option to have on there as well. We can't use the appropriate pronouns without first knowing what those pronouns are. Right. So besides the intake form, is there a way that you might suggest a CSD professional go about asking someone for their pronouns? Yes. So the best way to do that is simply using the script. So hi, I'm Dr. Robinson. You can call me Greg. My pronouns are they/them. And then you just open it up for their introduction. If their pronouns are always assumed to be right, they may not offer that piece of information. And you might ask at that point if you wanted to. But you've definitely have opened the door at that point for somebody else to share the same information that you just shared. And I can tell you that any trans non-binary person will hear that and will be absolutely delighted just from knowing that you have shown your pronouns. Also, I always put my pronouns on my badge. At our university, we have pronouns on our badges that we were given. That's another place to kind of normalize the pronouns sharing. In the second half of the podcast, Greg discusses the they/them pronoun and shares what to do when you make a mistake with your language. We'll hear that after this break. Support for Asher Voices comes from the Hand & Center. The Hand & Center's telepractice programs make it easy for you to involve parents and their child's early language intervention from the comfort of their homes. As a Hand & Member, you have the option to lead evidence-based parent programs online while maintaining best practice principles. Interactive group sessions, practice opportunities, and parent-to-parent support ensure the same high-quality learning experience as Hand &'s acclaimed in-person programs. Visit handand.org/telepractice. I wanted to ask Greg about the use of one particular pronoun, they/them. The first time someone hears this language, they sometimes respond with concern that it's going to lead to confusion because of the commonly heard plural form of they/them. I asked Greg what they would say to someone who has this concern and if there is a risk that they/them pronouns will create confusion. Well, I think that all pronouns create confusion if there's more people in the room because a lot of us share pronouns, but they should lead to no more confusion than the "you" pronoun because the "you" pronoun is technically both singular and plural and even when it's singular, it is grammatically plural. So that's an important thing to remember that you can be semantically singular but grammatically plural. So I wouldn't say you is smart. I would say you are smart and just like that, you would say they are smart if you're talking about one person or two people. But I would also say that anybody who thinks that they're not using the singular they and they are speaking the vast majority of American English dialects, they are fooling themselves. Singular they is used very commonly. If we were having a meeting and then we were all getting up and leaving and we noticed somebody left a cell phone, then you would say, "Hey, look at this. Somebody left their cell phone in here. Oh, I wonder who it was. Well, I hope they didn't leave." And I don't think anybody would say, "Oh no, somebody left his or her cell phone in here." It's a construct that was just in writing and relatively recently. Singular they has been in existence in the English language and documented, you know, even in Shakespearean literature or before, it's not anything new. This is something that is commonly used. The only thing that is slightly a shift is that we can use it to refer to a person that you are aware of. We don't assume the gender of that person. But I think that that's a very small shift. But you know that there are some people that, non-binary people who don't use they/them pronouns, there's other pronouns that are out there like "zee-zee-er" and even "fay-fair" is one of my favorites. So it's like, you know, there's lots of different pronouns that are a little bit less common but still being used. And I can tell you that if you go through the effort and you practice and you actually get the pronouns right, especially for the ones who are using pronouns that are a little bit rarer, it's super meaningful to that person. If this is new to someone or if they're encountering a pronoun they were previously unfamiliar with, there is a chance that there's going to be a mistake. You can imagine some CSD professionals may even avoid the topic out of fear of making a mistake. If you had any advice for someone, what would you tell them for what to do if they make a mistake? First of all, practice. You know, so those mistakes don't happen. But yeah, sometimes mistakes happen. And the best thing to do is just simply correct yourself quickly and move on to the topic that you're talking about. So don't draw a whole bunch of attention to it. A lot of people bless their hearts, as I say in the South. They apologize a lot. They get very stressed. They kind of beat themselves up and they call themselves names. And the big thing is you don't want to make this, you know, about you. You just want to correct yourself and move on. Do it quickly. I can tell you that like if I'm in the room with someone and they mess up on my pronouns and then they correct themselves. For me anyway, I can't speak for everybody. But for me, it almost is even more beautiful because it's just like, oh, wow, that person just noticed and corrected themselves. And I'm like, ah, the future is rosy and bright. I can, you know, I think this is going to work out. I think that that's the biggest thing is just don't over apologize, correct yourself quickly and move on to the topic. One more important point that we should probably talk about as well is, you know, when someone shares the pronouns they prefer and information about their gender identity, it's important to be careful how you speak about that with other people in front of other people. Is that correct? That's very true. I would like to correct you on one thing. Like you said, and I'm glad that you made the mistake. I love your mistake. It was perfect because it's a great example. The pronouns they prefer, I like to say that it's not that they prefer those pronouns. Those are their pronouns. Just like if you're a man and you were assigned male at birth, you identify as a man, you know, using he/him pronouns. Those are not the ones you prefer. Those, you know, it's not like, well, I'll accept she/her. No, it's like you, you probably wouldn't like that would be super distracting to you. I think that that's just important. It's their pronouns. Sometimes, though, some people will list multiple pronouns. They may say, I'm comfortable with they/them or she/her. And what I do generally is I go and I ask the person, I say, okay, so you have listed either they/them or she/her. Are you actually okay with both of those? Or is there really one that you prefer? And so in that case, it's good. I have to say that for a while I used they/them and he/him, but really he/him was, I was just putting that out there to make other people more comfortable. And so I need to stop that because I only have one life. So the question that you asked, what was your question about? Well, my question was about pronouns and using them in front of other people like family members. Yeah. Yeah. So that is important. I think it is important to remember that people may not be out to everybody. So sometimes it's a really good idea to talk to people and ask, can I use they/them pronouns for you? Or can I use this pronoun for you to everyone I see? Or do you need me to kind of specify that a little bit? I would love for it to be not as complicated as that. I love to be able to say, yeah, when people say their pronouns, you have to, you know, just use them and that's it. But the fact is, is that we live in a society and people who are trans and non-binary are walking around in a world where a good proportion of people don't see us. They don't recognize we exist or they don't acknowledge that we are important. So it is important to remember that that is a concern. Thank you for asking about that. The Asher Resource, Greg and other Lagasse members worked with the Asher Multicultural Issues Board to create is called Supporting and Working with Transgender and Gender Diverse Individuals. This document provides information on a number of topics, including pronoun use. It also refers to supportive environments, workplace, clinical and educational. I ask Greg about the origins of this resource. There was a time on social media when there were some statements from communication sciences and disorders professionals that were super concerning, where they were talking about the illegitimacy of, you know, they/them pronouns and they were very verbal about the fact that they would not be acknowledging the grammaticality or the authenticity of those pronouns. And it was a super kind of a really hard moment for a lot of us when that happened so publicly. And there was a lot of allyship that came out to try to counter that. But the way that I sort of responded to that was I was like, I don't know. I think that Asher needs to make this pretty clear. And I don't think this is as clear to everybody as it needs to be. And so I talked to my fellow Legasp person. We kind of like, we're like, yeah, maybe we should ask, bring this up to the Multicultural Issues Board and find out if there's maybe a position paper. One of the cool things that came out of that, though, was that they said, well, we don't really think this needs to be a position paper because it's kind of already in the code of ethics. It just needs to be clarified. And so I was like, okay, I like that that this is already acknowledged to be an aspect of ethical practice in our field by our organization that kind of governs us. So that's kind of cool. We decided to work on a frequently asked questions or an FAQ kind of a thing. And a lot of work went in it, a lot of checking with people, checking with community, double checking, and making sure that we said everything that we needed to say. So far, it's good. But we understand that times change. If there is a change that needs to be made, I'm hoping that we can kind of modify that over the years and keep it a living document as a guidepost for supporting trans and non-binary clients and professionals and anybody that we work with. Find the link to that resource on the blog post for this episode. That's at leader.pubs.asha.org. At the end of our conversation, Greg wanted to highlight a couple of important developments, including one with Legasp. Legasp is definitely growing. And I like to say that we're recuperating. There's some pretty strong homophobia that was happening within our field, kind of in the early 2000s. And a lot of people felt very unsafe in the LGBTQ community. And so it had a pretty big blow to our caucus. But we're definitely healing and growing from that. This year, there are two organizations. One is the LGBTQ graduate student organization. Then there's another initiative called the Trans Voice Initiative, which is a group of trans and non-binary speech language pathologists who do gender-affirming voice services. And they are developing this organization to train other trans and non-binary SLPs to do that kind of intervention that can really impact the field and impact the lives of people. So those are some great things that are happening. Greg, thank you so much for your time today. I appreciate it. Thank you so much. It has been a very big pleasure. Greg is founder of TLC, Gender Affirming Communication Group, a clinic offering gender-affirming voice services. Here a conversation with Greg about their work with gender-affirming voice services at that clinic. That episode is in the podcast archive. We'll find the link to it at on.asha.org/podcast. Both this episode and the episode on gender-affirming voice services were included in submissions to the AM&P Network Excel Awards. These association industry-wide awards recognized Asha voices with a gold medal in the category of podcast series. Overall, the Asha leader team won six awards for editorial content, ad design, and podcasts. And speaking of the Asha leader, find articles on gender inclusivity and SLPs and on how to ensure your practice is inclusive of all genders at leader.pubs.asha.org. And look for an article on gender inclusivity and audiologists in the July-August issue of the Asha leader magazine. And before we go, I want to highlight an additional Asha resource. Learn more with the webinar, building a culturally inclusive and gender-affirming space. This on-demand program features information about what you can do to help gender-diverse clients feel comfortable. It's available as part of the Asha learning pass or on its own. We'll put a link to it on the blog post for this episode at leader.pubs.asha.org. Asha Voices is produced by American Speech and Language Hearing Association and comes from the team behind the Asha leader magazine. Support for Asha Voices comes from the Hannon Center, break down barriers and reach more families with the Hannon Center's high-quality telepractice programs. Learn more about becoming Hannon certified and leading online Hannon programs at hannon.org/telepractice. Production assistance for Asha Voices comes from Pamela Lawrence, I'm JD Gray and this is Asha Voices.